MP42-05 FLUORESCENCE - TARGETED LAPAROSCOPIC LYMPH NODE DISSECTION IN PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Recently we have introduced fluorescence by means of Indocyanin Green(ICG) in addition to radio-guided dissection using Technetium 99(Tc99) for laparoscopic pelvic sentinel node dissection (Urology 2012). Since ICG also visualizes the lymphatic vessels it allows to better understand the lymphatic drainage of the prostate. Hence we could show that ICG alone gave equal results compared to TC99. Also the handling of this substance was much easier. Since ICG visualizes the complete drainage system we have as an evolution now left the sentinel concept to completely remove this template. We herein present the first results. METHODS: 38 consecutive men with intermediate and high risk prostate cancer have undergone targeted Lymphnode dissection during laparoscopic radical prostatectomy. The previous transrectal TRUSguided Injection of 2ml ICG into each lobe is now replaced by a transperineal approach, which is more precise. After removal of the complete ICG visualize Lymphnode template of each side, a standard extended LN-dissection was added as control. The Equipment for ICG eVisualisation was provided by Storz. All Lymphnodes were evaluated by 250 micrometer sections and imunohistochemistry. Data were collected prospectively and analyzed retrospectively. RESULTS: Transperineal Injection allowed for precise deposit of the tracer within the peripheral zone without any periprostatic extravasation. Fluorescence stained (F+) nodes were found on both sides in all patients except one. In total 596 nodes (17,9 +-8,4/patient) were removed, of which 473 nodes (14,3 +8,51/pat.) were F+. LN Metastases(pN1) were found in 15 pat.(39,5%), of which 2 pat. (5,3 %) had a solitary micrometastasis. In additional 3 patients (7,9 %) Tumor Cell Cluster were found in lymphnodes. There was not a single patient where non-stained metastases were found in addition to F+ Metastases. In the one patient, where there was no staining at all, a solitary metastasis was found in the template of the extended PLND. Metastases outside the template of extended PLND occurred in 5 patients(27,8% of N+). Since we always perform extended PLND, when there is no Fluorescence staining at all, no metastases was overlooked with our concept. CONCLUSIONS: Fluorescence-targeted lymphnode dissection allows to identify the lymphatic drainage of the prostate with great reliability. It proved to be more precise than extended lymphnode dissection in patients with intermediate and high grade prostate cancer.